UNIT 7 Role Fidelity: Assignment 1: Review Question A

Assignment 2: Review Question C

Assignment 3: Review Question D

Assignment 4: In the News – page 156

Assignment 5: Case Studies – page 157 & 160

Assignment 6: Please read the following New York Times article and post your comments on the Discussion Board.

“Whistle Blower Suit Says Device Maker Generously Rewards Doctors” by Reed Abelson from January 24, 2006.

Assignment 7: Please read the following New York Times article and post your comments on the Discussion Board.

“Blowing the Whistle, Many Times” by Mary William Walsh from November 18, 2007.

Reading Assignment: Chapter 7

Disparagement of Professional Colleagues

· In the practice of health care it is easy to find marginal professionals.

· Criticizing marginal professionals in front of patients not only harms the practitioner but harms the relationship the patient has with the other members of the profession.

UNIT 7 Role Fidelity: Gaming the System

· Definition

· Gaming the system for patient benefit.

· Does the intent make the difference?

· Ethical principles that are sacrificed

· Negative consequences

· Lying undermines a practitioner’s credibility.

· Lying undermines the credibility of all health professionals.

· In a world of finite resources, does gaming for one patient take from another patient?

Conflict of Interest

· Fiduciary relationship

· One of the elements associated with a profession

· Conflict of interest.

· Basic principles involved that exist for ALL decision makers at all levels within an organization.

· Board members, physicians, and employees are required by most organizations to submit a disclosure form that discloses potential conflicts related to decisions that may arise.

· Practitioners who change their way of practice through any motive other than patient benefit may have embarked on a “slippery slope” of compromised ethics.

· In medical research, the researcher’s interests may be placed above the interest of the patient.

· Example: the researcher may be fearful of loosing financial backing for the research project, and may state incorrect data or test results in order to have the research appear more successful than it is.

· Conflicts of interest where patient interests are served

· Does intent make the difference?

· A young man signed up for a genetic research protocol. Following a severe reaction, he died.

· The physician researcher was well respected and qualified

· The protocol had been approved

· Would it make a difference to you to know that the physician had a financial interest in the genetics company that supplied the material used in the injection?

Impaired Colleagues

· Basic problem involved

· Basic principles involved

· When healthcare provision is compromised, the practitioner guided by the principles of role fidelity and nonmaleficene has a duty to interfere.

· Rationale for a duty to act

· Protection of patients

· Protection of specialty

· Protection of colleagues

· Protection of institution

· Protection of practice

Whistle Blowing

· Definition

· Whistle blowing may be a response to moral outrage.

· Employees have both the right and responsibility to report unethical conduct.

· Whistle blowing has been defined as an act of someone “who, believing that the public interest overrides the interest of the organization he serves, publicly blows the whistle if the organization is involved in corrupt, illegal or fraudulent, or harmful activity.”

· Downside

· What principles are involved?

· Making the decision

· Elements to consider

· Justification of Whistle blowing

· The wrong doing in question is grave and has created, or is likely to create, serious harm.

· The professional who is contemplating whistle blowing has appropriate information and is competent to make judgment about the wrongdoing.

· The professional has consulted others to confirm their information and judgment.

· All other internal resources to resolve the problem have been exhausted.

· There is a good likelihood that the whistle blowing will serve a useful purpose.

· The harm created by the whistle blowing is less than the harm done by a continuation of the wrongdoing.

Ethics Committee

· An ethics committee is an interdisciplinary group of health care providers, community representatives, and non-medical professionals who address ethical questions in the health care institution regarding the care of patients.

· They are advisory groups on policy and sometimes on cases that involve ethical issues.

· It is their responsibility to make the best informed opinions about issues available to those who request their advice.

Role of the Ethics Committee

· Ethics Committees are about the process of sharing ideas.

· The actual decision makers remain the same: physicians, nurses and patients.

· The strength of the ethics committee is in its democratic make-up and its understanding of its community.

· Some see the ethics committee as an alternative to litigation.

· There is an increasing in making ethics committees responsible for organizational ethics and applying the principles of ethics more broadly.

Who is on the Ethics Committee?

· Should be members who are respected by their colleagues for their clinical judgment and interpersonal skills.

· The membership reflects the health care facility and should also contain representatives such as: educators, clinicians, legal advisors, political leaders, members of the clergy, quality improvement leader, corporate leaders from the business community.

· The average committee has about 10-15 members.

· Many committees include an ethicist.

· A person who has received special training in bioethics, often as a doctoral candidate, and has the responsibility of providing the committee with education on the methods and trends concerning the ethical and legal issues in healthcare

· The usual length of membership on an ethics committee is two years, with reappointment to a second term of two years.

· The meetings of many ethics committees are conducted monthly, with the minutes kept by a secretary or a member of the committee.

Goals of the Ethics Committee

· Support and foster decision making by providing guidance to patients, families and decision makers.

· Review cases, as requested, where there are conflicts in basic values and assist in clarifying situations that are ethical, legal, or religious in nature that extend beyond the scope of daily practice.

· Help clarify issues, discuss alternatives, and compromises.

· Provide institutional imput and perspective.

· Determine what should trigger an ethics consultation.

· Facilitate knowledgeable reflection on ethical issues and concerns.

· Provide guidance, not decisions.

· Promote the rights of patients.

· Promote shared decision making between patients and their clinicians.

· Assist the patient and family, as appropriate, in coming to consensus with the options that best meet the patient’s goal for care.

· Promote fair policies and procedures that maximize the likelihood if achieving good, patient-centered outcomes, and

· Enhance the ethical tenor of both healthcare organizations and professionals.

(Source: Pozgar, p.73-74.)

Functions of the Ethics Committee

· The functions are multifaceted and include:

· Development of policy and procedure guidelines to assist in resolving ethical dilemmas.

· Staff and community education

· The first task of a new ethics committee is self-education

· All members must have a basic understanding of ethical principles and thought

· Members should be encouraged to attend ethics conferences and seminars

· Conflict resolution

· Case reviews

· Support and consultation

· Political advocacy

Institutional Ethics Committee (IEC)

· Genesis of need

· Membership

· Common functions

· Policy and procedure development

· Educational role

· Case consultation

· Retrospective case review

· Decision making not a function of the IEC

When conducting a formal consultation, ethics committees should:

1. Identify the ethical dilemma.

· Be sure the appropriate “Consultation Request” form has been completed

2. Identify the relevant facts:

· Diagnosis and prognosis

· Patient goals and wishes

· Regulatory and legal issues

· Professional standards and codes of ethics

· Institutional policies and values

3. Identify the stakeholders.

4. Identify moral issues:

· Human dignity

· Common good

· Justice

· Beneficence

· Respect for autonomy

· Informed consent

· Medical futility

5. Identify legal issues.

6. Consider alternative options.

7. Conduct consultation

· Review, discuss, and provide reasoning for recommendations made

8. Review and follow up.

9. Committee discussion should include family members once the committee has had the opportunity to review the request for consultation.

10. Family members should be asked what their hopes and expectations are.

11. Each formal consultation should be documented and review at subsequent ethics committee meetings for educational purposes.